Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Practice Guideline
Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. ⋯ The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.
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Older adults are at increased risk for malnutrition. The aim was to investigate the prevalence of and risk factors for poor nutritional status in oldest-old Chinese. ⋯ The findings suggest that the majority of the Chinese oldest-old were at risk for malnutrition. Nutritional assessment should be incorporated into regular geriatric screening among community-living oldest-old in China. Interventions targeting those at risk for malnutrition should be developed to improve health outcomes among this vulnerable population.
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Randomized Controlled Trial
Perioperative perturbations in carnitine metabolism are attenuated by preoperative carbohydrate treatment: Another mechanism by which preoperative feeding may attenuate development of postoperative insulin resistance.
Fasting increases lipid flux into mitochondria causing excessive β-oxidation, carnitine acylation and impaired cellular glucose uptake. Preoperative carbohydrate treatment (PCT) attenuates postoperative insulin resistance, but mechanisms underlying this and the effects on carnitine metabolism remain largely unknown. ⋯ Preventing excessive/incomplete mitochondrial β-oxidation, characterised by perturbed carnitine metabolism, may be a mechanism by which PCT attenuates the reduction in postoperative insulin sensitivity.
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Randomized Controlled Trial
The effect of perioperative glucose control on postoperative insulin resistance.
Postoperative insulin resistance and the consequent hyperglycemia affects clinical outcome. Insulin sensitivity may be modulated by preoperative nutrition, adequate pain management and minimal invasive surgery. This study aims to disclose the impact of perioperative glucose control on postoperative insulin resistance. ⋯ This trial revealed a significant difference in postoperative insulin resistance in the group treated with insulin during surgery.
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Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodstream infections in critical care patients receiving parenteral nutrition (PN) prepared via conventional compounding versus premixed multichamber bags. ⋯ In this retrospective review of a large patient database the adjusted probability of bloodstream infection was significantly lower in patients receiving multichamber bags than compounded parenteral nutrition. These findings need to be investigated further in high quality observational studies and prospective clinical trials.